How C19 Spreads

It’s likely that a considerable time will pass before we have access to a vaccine, too much time for us to remain hunkered down in an airlock, waiting. We’ll need to absorb a more nuanced understanding of real risk factors in order to make personal decisions and influence reasonable policy.

What follows is a layman’s summary of the very spotty available research as of May 2020. Almost all of the available information is preliminary, based on small samples with little if any experimental validation. It’s marginally better than anecdote, yet it’s all we have to work with for now. Use with caution.

Why should anyone who isn’t an epidemiologist even attempt to summarize this data? Thanks to the abdication of leadership by our government, we all have to process this information and make decisions on it, with or without any competence. Feedback and corrections are welcome, but we all have to start somewhere.

Since SARS-CoV-2 is a new virus, the research community is only just beginning to do controlled experiments. Therefore, all the information we have comes from observing patients who were all infected in different ways, have different underlying health conditions, and are of different ages and both sexes. This diversity makes it difficult to make strong conclusions that will apply to everyone from only observational data.

How do you contract C19? At a summary level, to become ill with C19 a patient must get a threshold load of C19 virus particles into vulnerable respiratory membranes. Transmission seems to occur mostly by particles reaching the nose or throat via airflow, but sometimes through the eyes. There is no evidence of transmission via food. Contaminated surfaces could theoretically be a vector for C19 spread, but no contract tracing has yet identified a case. Transmission via touching a surface would require an intersection of many unlikely coincidences and might not be viable on any mass scale.

When discussing transmission vectors, it’s important to remember a key difference between viruses and bacteria. Viruses cannot replicate outside a host. There is a vibrant debate about whether viruses are living things at all. We are used to scrubbing down counters and guarding against surface contamination because bacterial pathogens can grow and thrive in almost any environment. A virus on a surface is merely waiting to die. It needs a lot of help to survive. A lot of the hygiene practices we’ve absorbed for other purposes don’t have the same relevance with C19.

How much of the virus is necessary to cause an infection? We’re not sure, but we have some clues.

“Viral load” is the quantity of virus particles present in a sample of bodily fluid. There is a threshold amount of exposure to particles of a pathogen necessary to initiate an illness. Patients’ viral load will vary over the course of their illness, and by certain personal traits. How much of the virus a patient “sheds” via different emissions also varies.

For comparison, exposure to one particle of the Norovirus is associated with a .5% chance of developing the illness. It’s estimated that exposure to as few as 18 particles can reliably launch the norovirus illness in most subjects. With most pathogens, the viral load to which a patient is exposed in their initial infection can influence the severity of the illness. Research on C19 is producing contradictory results on this question.

What viral load is necessary to spread C19? This is not settled, but based on mouse studies on earlier SARS viruses, it seems likely that the necessary viral load is around 1000 particles. For comparison, the infectious dose of Influenza A is about 200 particles.

That might seem like good news, except for one of the unique characteristics of C19. With the flu, patients shed the highest volume of the virus as their symptoms peak. C19 patients seem to shed peak volumes of the virus just before the onset of symptoms. Viral shedding appears to begin about 2-3 days before onset of symptoms. One study found that 44% of the cases traced had been transmitted by a pre-symptomatic patient. This sucks, because it makes it harder to contain the disease by screening for symptoms. This pattern of presymptomatic transmission helps explain why C19 has become such a dangerous pandemic despite in many other ways being less virulent than other common illnesses.

What is the viral load expelled by a cough, speaking or sneezing? How much C19 is contained in, for example, a patient’s sneeze? We don’t have an experimental answer, and any answer would be influenced by the patient’s viral load at that time. We do, however, have some idea of the density of droplets expelled in different interactions.

A cough releases about 3,000 droplets. A sneeze, 30,000. A single exhale anywhere from 50-5000. Droplets exhaled during speech can vary exponentially based on volume. How much virus might be contained in a single droplet could vary based on the virus, the patient’s viral load, and the stage of that patient’s illness, but for comparison, a single sneeze could expel hundreds of millions of virus particles from a flu patient at the peak of illness. Most falls to the ground quickly, but some could remain suspended in the air for some time.

Speaking increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose.

The exposure to virus x time formulae is the basis of contact tracing. Anyone you spend greater than 10 minutes with in a face-to-face situation is potentially infected. Anyone who shares a space with you (say an office) for an extended period is potentially infected.

How are you most likely to contract the disease? In China the top risk factors were “living with the case (13.26%), taking the same transportation (11.91%), and dining together (7.18%)” with those percentages representing the odds of spread, not the prevalence of that particular vector. Risk of cross-infection within a hospital was low, less than 2%.

Certain environments that combine close quarters, long personal contact, or consistent exposure to carriers have developed into “super-spreaders,” accounting for large multiples of spread. Prisons, nursing homes, meat-packing plants, churches, restaurants and call centers have been identified as particularly virulent environments.

A study of a call center in South Korea highlights the potential risks of almost any closed environment, especially the open-plan offices that have become common in recent years. Mere speaking releases far fewer virus particles than sneezing or coughing, but an environment in which people are speaking consistently, in relatively close quarters, for hours on end in a closed indoor ventilation system can quickly build up the necessary airborne viral load for transmission. The call center research suggests that concerts, sporting events and nightclubs might also be hyper-spreading environments.

Other high-contagion environments have been funerals and church services. An explanation may come from a study on a choir practice that became a super-spreader event. In Mt. Vernon, WA. A choir practice on March 10 with 60 participants, none of whom were symptomatic, led to 45 cases and 2 deaths. Members were careful to maintain social distancing and used hand sanitizer, yet 2 hours of shared air was deadly. A single breath may contain very few virus particles, but multiply those breaths by minutes and then hours, and a small exposure can grow exponentially.

What kinds of interactions appear less likely to spread the virus? There is almost no available evidence of outdoor exposure, minus direct personal contact. A Chinese study of 318 outbreaks found only one based on outdoor exposure. Brief, low-contact interactions are very unlikely to spread the disease without a cough or sneeze.

There is some evidence that even in households with an infected member, proper sanitary and mitigation methods may successfully limit spread. Studies are finding that the “secondary attack rate” of the disease within households ranges between 16% and 10%, much lower than one might expect. In China, close personal contacts of infected medical staff very rarely contracted the disease, suggesting that the disciplines around hygiene and mask-wearing well-engrained among medical professionals can limit spread even within households.

Masks, even relatively simple ones, can be helpful by limiting the range of spread of aerosol particles from breath, coughs and sneezes. Masks do not prevent the spread of the disease absolutely. Few of the masks in common use successfully filter out particles from the air we breathe. They act as a damper, limiting how far breathed particles spread, thereby suppressing risk factors. Masks aren’t a fix. They are a suppressant. Combined with social distancing and limits in sustained contact, they can be a vital key to reducing transmission.

What does this mean for the shape of any potential end to a lockdown? We can begin to resume something like normal life once we’ve implemented testing and contact tracing. At the end of January this would have been a manageable process. Had the Administration consulted and followed its own pandemic playbook when the first case was detected in January, lockdowns might have been limited to the Seattle and NYC areas, we might not have needed more than a few thousand tests per day, and contact tracing might have allowed life to proceed more or less as normal across the rest of the country. Too late for that now.

For normal life to resume, even after initial availability of a vaccine, testing and contract tracing would have to happen on a historically unprecedented scale. It still has to happen, regardless the cost or complexity. Even after a vaccine is available, testing and tracing will remain a necessary gateway to normalcy.

Since our leaders are incapable of meeting this challenge, what do we do in the meantime? Until a vaccine and a testing/tracing scheme is enacted, there are certain environments which will remain lethal. Common environments like churches, nightclubs and dine-in restaurants probably cannot resume anything like normal function, safely. Sporting events and concerts are out of the question. Anyone calling workers back to an office, especially a call center, or the close environment of a meat-packing plant is guilty of negligence per se. Meat packing plants could perhaps operate safely with workers protected by safety respirators and eye protection, but this would also require shorter shifts and impact safety and effectiveness.

Grocery stores and other retail might be able to operate safely if their indoor spaces are sufficiently large, workers and patrons wear masks, employees are consistently tested, and careful crowding controls are maintained. Commercial air travel meets all the high risk factors for transmission, though airlines have been highly secretive about cases.

A month ago we learned that over a hundred American Airlines attendants and 41 pilots had tested positive. The LA Times reported three weeks ago that 15 flight attendants had died, but the industry is not posting up to date stats. We have no information about testing rates or infection rates among attendants.

Mass transit, by contrast, appears relatively safe. Big, dense cities like Hong Kong, Taipei, Tokyo and Seoul have been very successful containing the disease without ever closing mass transit. Compared to air travel, mass transit involves brief interactions, with rarely any talking, and we’ve learned that surface contamination is a rare vector for transmission, if a vector at all. How often does anyone spend 3 hours in a subway car? And if they did, they wouldn’t be packed in next to the same person that whole time. Urban mass transit is orders of magnitude safer than air travel.

Meanwhile, we probably don’t need to worry about our mail, your Amazon packages, or our food. Hand washing would be an effective response to any surface-based transmission and this ritual of washing all my groceries is more religious than preventative.

Short-timeframe, outdoor interactions, such as during walking or jogging, probably cannot transmit the disease without someone sneezing on you. And even in a home with a C19 patient, reasonable sanitary precautions can limit the odds of further transmission.

We are in for the long-haul. No helping is coming before the election. Even with a vaccine, the disease will remain a factor in our lives for months or years to follow. Maintaining an OCD level OCD paranoia is too much to ask. As data becomes available to separate the real threats from the unreal, we should make reasonable adjustments.

Go outside. Get used to the mask. Relax about the groceries and the deliveries. Stay away from crowded indoor spaces. Be kind to people. If you’re fortunate enough to have an income during this time, be generous. In fact, find ways to be generous even if it hurts. It’s a way to maintain connection. Brace for years of inconvenience and start thinking about ways we can use this disruption to build a better world.

Chris, how do you feel about the California special election that flipped district 25 from blue to red w/ a 12 point lead? The general media consensus seems to be that this will embolden Republicans to hold a hard line against mail-in ballots as Democrats are more likely to stay home to protect their health.

Well, for starters that election was conducted with mail-in ballots. Second, it’s an historically red district where no Democrat even made the final ballot as recently as ’14. Katie Hill’s win there in ’18 was a stunner. Nevertheless, Garcia is renting that seat. No one is paying the slightest attention to elections right now. If you want to know what the November results will look like, refer to ’18 and add two or three points to the Democratic margin.

My own parents are in Kerala, the Indian state mentioned in the article and one of the most densely populated states in India, while I am in Los Angeles. My parents talk of 1 case of infection detected in their entire district a few days back as a disaster, they talk of how every person that victim had come in contact with getting quarantined and tested, they talk of how every household was provided with basic groceries so nobody had to go out and shop. I listen to it and think I would not be surprised if there are dozens of infections on my residential street here in LA.

Nobody talks of success stories in Kerala, Vietnam and other places. But Germany, which has more deaths in a day than these places have had over the entire period in spite of being 1000s of miles from China, is held up as an exemplary success story.

UV as a disinfectant is certainly a tool. I have long been aware of it and designed UV disinfection facilities for water and wastewater treatment plants numerous times prior to retirement several years ago. Until changing hearing-aids recently my overnight storage container used UV to disinfect them. However it is dangerous and must be used with protective equipment and in unoccupied spaces. However, I was not aware of far-UVC and its potential for use in occupied spaces until watching the video. However, even though initial studies have been promising, it will take some time for appropriate dosages to be determined and for experience to fully validate its use.. For the use of far-UVC for ordinary facility and residential use, it will take additional time for manufacturers to design appropriate fixtures. In other words, it is a tool that is of interest. But not a panacea. Initial application will likely be in continuously occupied spaces such as airports, transportation facilities and other public spaces with a high potential for cross contamination. As a Professional Electrical Engineer, I would be very cautious regarding its application until appropriate approvals are in place.

Also during this time of high anxiety and fear, caution to avoid irresponsible hype and scamming will be necessary. We have too many recent examples of that, such as hydroxychloroquine and high doses of UV light both internally and externally on the human body to kill the coronavirus. Also note that this is for far-UVC, which is a different type of light (different frequency) than normal UV and UVC. As the video showed the disinfecting machines all require use in unoccupied spaces as UV lighting is dangerous when not applied correctly.

Chris, I would happily join those nutbars if anyone suggests deploying UV lighting of ANY kind. Do your own research from any credible source, no quack sites. UV A and B have virtually zero impact on bacteria and viruses, but B is the one that tans you, and that can cause cancer. UV-C is blocked by the ozone layer, thank goodness. It causes skin cancer and massive eye damage. And yes, it is lethal to pathogens, but impossible to use around living creatures.

This whole discussion shows the difficulties we have in the US regarding technology. UV is a proven method of disinfecting, but it must be applied correctly. the UV in sunlight does disinfect things but it is a small dose and it does work over a period of time. Based on the CNBC link, far-UVC appears to also function as a disinfectant and may be safe for use in occupied spaces. But this is very preliminary and must be proven. My 50+ years of experience, indicates several years of R&D will be required for far-UVC to be ready for deployment. Yet some are ready to jump on the bandwagon and others are going ballistic in regard to this. Yet the same conspiracy theorists, such as the anti-vaxxers will immediately snap up the latest technology offerings from Apple and Samsung. Those companies are rushing technology into production sometimes without doing adequate due diligence and testing. Our POTUS goes to “cocked and ready” on the basis of some half-listened-to message on Fox or a powerpoint presentation at which he only quickly glanced. And he and other politicians ignore qualified technical experts because the advice the experts are giving does not conform to their preconceived notions. That was apparent in the Senate Hearings yesterday with Fauci and the other public health experts.

People do not listen or attempt to understand a subject prior to making a decision and shooting off their mouths. No wonder, we are so divided. And regarding technology deployment, some things are handicapped by the conspiracy theorists, yet when it comes to some consumer products technology is deployed before it is ready and proven.

What this entire travesty demonstrates is the general technical illiteracy of americans. To be fair, it is like this in the majority of countries, where the technical elite is really a tiny percentage of any population. In the states of course it is worse, where the fascists have engaged in a program for generations that preceded the movie Idiocracy.

In the states, “elite” and “science” have taken on the meaning of evil. BTW, Chris, I read Canticle of Lebowitz, one of your recommended books, I would have loved for Miller to look at today’s america and compare that to the Simpleton’s in that book. For those that have not read it, that is a group that took on that name with pride, and murderous vengeance.

Thanks for video. (If one ignores the dangerous advice shown in the video by potus to use UV light on, and, internally!!). This information tracks other solid findings that UVc, especially, can become a valuable disinfectant tool.

Great piece of writing and very informative.
I must say that those of us in our “golden” years are not going to spend them hugging our grandchildren – especially if compromised immune systems and inflammatory conditions are part of one’s medical profile. It’s discouraging, but, it is what it is.

Sheltering in place has been more challenging for families, especially those with children – of any age. Sheltering for older people is hard in a different way. It’s lonely and isolating. I expect many seniors are going to develop secondary nutritional issues. Emotional health is a challenge with a serious commitment to covid vigilance. Job loss and changes are no less significant in their impact.

Those who pay attention know the trump administration has already made the calculation that large numbers of people will die, and, they are fine with that. It underscores theIr casual, even sloppy response and the rush to “get on with things”. Narcissism is wonderful insulation from fear of physical harm. There is great irony in watching the covid circle draw closer to the men in the center, although privilege has its advantages always, and they are tested daily.

It’s sad to think of what “could have been “ in terms of a more effective response to this virus. Lives saved, jobs retained, lives lived in relative normalcy.

I read a recent poll that showed only one in five people think they will take the vaccine once it’s approved. Fear of rushed process, fear of any vaccines (thank you anti-vaxers), lack of trust in mixed messages, some because they believe they are invincible.

I look forward to a post on the gaming of the virus response by this administration.

That aside, it’s depressing to think about it, but it’s nigh inevitable now that millions of Americans are going to have to put themselves at risk to oust the Narcissist-in-Chief. Because of course he’ll make people risk their lives themselves if it gives him even slightly better odds.

Chris, you are wrong in one area. At least one. But this one I am certain of.

The virus can and does live for extended periods of surfaces.
Various surfaces support varying lifespans, but some are as long as 5 days.
So no, mass transit is a risk, but that risk is heavily mitigated with stringent cleaning protocols.

I see that many more are coming around to my originally very unpopular stance that we are all going to be exposed eventually, and the economic devastation (and attendant social and health issues with that) outweighs the loss of life saved with total lockdown.

I hate agreeing with the sociopaths, but they are right in this case. I full well know that there is no politician or pundit that is going to say “We have to accept 1% of the population dying to protect the a sizeable chunk of the rest of a generation of economic hardship.” But that is the cold hard fact.

And the next person that says to me “You first”, I will tell them the truth. I have maintained my lifestyle as best I can, and if I get infected, so be it. In the long run, when the global economy opens up again, those that had the virus, survived, and have documentation will be far more employable than someone who stayed home and has no antibodies.

And yes, I am fervently hoping that both the tyrant and the vp both get it. Imagine a situation where both are incapacitated at the same time….

Look closely that those “lifespans.” What you find in those very long examples are that intact RNA was found for very long periods. That bears no relationship to the ability of the virus to successfully replicate, merely that enough of its constituent material could be detected to identify it for long periods. Real, transmissible timeframes are probably a few hours under the most favorable circumstances. Even then, the challenge of transferring enough of that viable material to a respiratory membrane by touch remains formidable.

I’ve been unable to locate a single example of surface-based transmission from the available contact tracing. There is one suspected case. Just one. It happened in Singapore where an infected person sat in the church seat of someone who had sat there in a previous service. They’re still not confident the transmission didn’t come from another source, but it’s their best case. That was out of 500 or so contact traces there and tens of thousands in S Korea.

If surfaces were a viable transmission method then S Korea would have been overwhelmed after their decision to keep their transit system open.

Agreed that surface-based transmission seems very low risk, and surface-to-surface can be ignored. I think you’re still a little sanguine about mass transit though. A person can easily wind up sitting within six feet of several other people for 30 minutes or longer. And I recall reading of one mass transit transmission case where the distance was 15 feet. What really matters is air circulation and filtering. Airlines claim to have HEPA+ level filtering, which would be great, but I wouldn’t trust it to always be working to spec. But most mass transit does not have any filtration, just circulation and venting. So I’d like to see buses running with the windows at least partly open.

And as for letting the virus work itself out, for some reason people living in the Pacific Rim don’t face this choice. Why should we? And this isn’t the flu. We’re seeing long-term debilitating conditions emerge from this infection in ways that are starting to look like a cross between lyme disease and AIDS. How much benefit do countries enjoy from letting malaria run its course? We’re gonna have to wise up to what we’re facing or experience the kind of civilizational downgrade that could be permanent.

I am not going to profess to be a medical expert. All I can go on is numerous websites, all quasi government sites, and preferably non-Chinese, non-Russian, and non-American, to get actual data, not propaganda. I trust British, Canadian, Aussie, NZ, and many Euro sites. Plus of course WHO.

And as for the virus evolving, or more specifically, new symptoms and conditions now being found, yes, they are scary, perhaps horrific. But the genie is out of the bottle in many many countries. Yes, NZ, SK, Singapore, Taiwan, Australia, among others, nailed this early, either through luck, good management (had to have that), demographics, or a combination.

None of those things occurred in most of the world. And now, it is too late, unless you are prepared to live with a 30-50% cut in GDP until a vaccine is found (if one can be found), tested, manufactured, AND distributed to the entire planet. Or do you imagine the HAVE (in this case, HAVE a vaccine) cutting off all contact with have-not countries, and any potential secondary and tertiary contact. Brazil is going to end up in civil war over this one, with their own tyrant laughing about the virus.

Or perhaps. HAVE states cutting off all contact with Have-Not states. You KNOW that the tyrant will divert vaccines away from blue states until all red states have been completely inoculated. And yes, the tyrant will still be in charge next year.

Is this the new polio, or the new smallpox? No one knows. But I will say again, the damage that comes with a 30% plus drop in GDP, with 25% of the population out of work, without any kind of medical safety net, starving, and homeless will lead to a revolution.

Lamar Alexander said today, “we can’t help everyone”. Now, of course he was, and is, a monster of the worst sort. But his kind hold the purse strings, and that is exactly what is happening now. It is only going to get much much worse, if people don’t accept a lot of death to avoid even more.

I guess it comes down to this: As for the U.S. “wising up” , precisely what indicators do you see that show that ever happening?

“Wising up” would mean completely upending the American political system (reversing states’ rights trump federal mandates), health care system (universal health care is mandatory), wealth distribution system (the poor must be protected as much as the rich in order to protect the rich in the long run) in about 2 weeks. Plus, the U.S. would have to have unified political will in the WH, Senate, and the House, and actual leadership in the WH. You know exactly what the chances of that are.

No, the U.S. is a failed state, and this virus has come along at the precise time when the fault lines are at their weakest, and the entire system is about to fall apart.

If Wisconsinites can stand in the face of every obstructionist tactic and the proverbial kitchen sink to deliver a double-digit win for Democrats, we can blow Trump out of the water and deliver a solid trifecta in November.

Humans are capable of absolutely anything, but you close the door to possibility if you’ve convinced yourself you’ve already lost. In that way, you’re doing exactly what Trump wants you to do. Don’t.

More proof that the u.s. is a failed state and “humans are capable of absolutely anything”: Musk just told the gov’t of California “you have no power”, opened up his factory, and the governor said “it is a county decision.”

But yeah, there will be cohesive, effective command and control in the coming months and years…….

Ryan, optimism and hope are fine when there is the potential of good things happening. We don’t live in that world.

In the past 48 hours:
a. Wisconsin congressional seat falls to the fascists. You know, that state where everyone was crowing about the Dem’s aka loser party were fighting back.
b. SCOTUS signals they are going to support the tyrant, this time making him invulnerable to any investigation, and by extension, any investigation of his regime.
c. Federal Reserve Chairman Jerome Powell said this morning that almost 40 percent of households earning less than $40,000/year (as of February) lost their jobs in March.

But hey, you keep on being optimistic and having hope. Others will try to deal with reality.

>] “But hey, you keep on being optimistic and having hope. Others will try to deal with reality.”

Tell me, Dins, why do you seem to think it’s a choice between confronting reality and being optimistic? Seems to me that the only way you get there is a mindset that believes, IMO, that humans are too fundamentally weak to be able to confront an awful situation without falling into despair.

People *always* have a choice in how they choose to respond to any given situation, no matter how awful. That doesn’t mean not enduring suffering or being guaranteed to change the outcome, but the only one in all the world who can decide how to confront anything is you.

You’re pessimistic about our current political situation because you’re invested in being pessimistic. If I had to throw my two cents in as to why that might be, I’m inclined to think it’s because it’s easier for you than being optimistic. And true enough, embracing hope is rarely ever easy and it’s often met with endless disappointment. It’s a harsh road, but that’s no reason to give up.

If being able to look back on your life with a sense of pride and satisfaction means anything to you, then that’s the only road to go down.

“We have to accept 1% of the population dying to protect the a sizeable chunk of the rest of a generation of economic hardship” seems to mean “We have to accept 1% of the population dying to protect corporate profits and valuations of the stock market.”

The economy is going to be a lot smaller and quite different for a while, that much is sure. How much suffering and hardship ensue will depend on choices we make.

The data seems to indicate a strong correlation between obesity and covid infection mortality rate. Probably the best course of individual action we can take to protect ourselves would be to focus on getting our body and immune systems into top shape.

I can confirm, the keto diet works wonders for shedding pounds quickly. The peripheral health benefits are up for debate, as with veganism, Paleo, and all lifestyle-type diets. But getting rid of unnecessary weight your body has to spend resources maintaining seems to be key.

I have been following a low carb diet for the last year. The doctors I follow think that that reversing insulin resistance enables your body to fight off infections including covid19 better. I know for a fact that it has reverse type two diabetes for me and the wife. I am off all meds and my a1c is now 4.7% where it before was 6.4%. Every prediction the doctors I am following have pan out correct. This diet has been known since very early in the 20th century that it cures most type two diabetes. That was forgotten after insulin was invented until a couple of decades ago. But a diet change produces no profit for drug companies who have large amounts of money to suppress information like this and lobby governments to promote their interest.

I may have been exposed two times over the last 5 months to the virus. So far no symptoms. I use to have colds , not one time since I changed my diet. I am thinking when I do blood work again to have it checked for the anti-bodies for covid19. But a lot of the test being used currently are not accurate. There are so much misinformation and political correctness in what should be cut and dry science.

One of the doctors I follow thinks eventually all of us will be exposed. But to delay that as long as possible so we do not overwhelm our healthcare system. The longer time runs the more doctors will know about the virus and how to treat people with it. He suggest to use that time before infection to get our metabolic health in order with a low carb diet to be in the best shape to deal with the virus. He says even with flu vaccine people still can get the flu and thinks the same situation will happen with covid19 after we have a vaccine.